ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION

Size: px
Start display at page:

Download "ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION"

Transcription

1 ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION This Addendum to PHYSICIAN SERVICES AGREEMENT ( Addendum ) is made by and between Mount Carmel Health Partners, Inc., an Ohio corporation ( MCHP ) and, a physician licensed to practice in the state of Ohio ( Physician ), referred to collectively herein as the parties or individually as a party. WHEREAS, MCHP and Physician entered into a certain Physician Services Agreement ( Agreement ), for the purpose of improving the quality and delivery of integrated health care in central Ohio; and WHEREAS, the parties now desire to amend the Agreement to provide for the supervision of allied health professionals ( AHPs ) by the Physician, and thereby expand quality care delivery opportunities for Members. NOW, THEREFORE, in consideration of the mutual promises and covenants hereinafter contained, and other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: 1. Definitions. For purposes of this Addendum, the terms Certified Nurse Practitioner ( CNP ), Certified Nurse Midwife ( CNM ), Clinical Nurse Specialist ( CNS ) and Physician Assistant ( PA ) shall be defined pursuant to the Ohio Revised Code. 2. Memorialization of Supervisory and Collaborative Care Relationship. Physician hereby acknowledges the execution, by and between each of the AHP(s) (as identified by name and licensure category, and listed in Exhibit A attached hereto) and Physician, of one of the supervision agreements described below (each individually a Supervision Agreement ), and has attached cop(ies) of the same to this Addendum: a. A Standard Care Arrangement, as defined by, and containing all elements required by ORC , OAC and OAC ; or [THIS SECTION IS APPLICABLE IF AHP IS A CNS, CNP OR CMN.] b. A state-approved Physician Supervision Agreement and Physician Supervisory Plan, as defined by, and containing all elements required by ORC through ORC ; or [THIS SECTION IS APPLICABLE IF AHP IS A PA.] c. Other written agreement, approved by MCHP, specifying the scope of services to be performed by AHP(s), and the scope of supervision to be provided by Physician in accordance with applicable Ohio law

2 3. Supervisory Duties. a. Physician agrees to supervise and oversee the practice(s) of AHP(s) in accordance with the terms of the Supervision Agreement(s), as attached hereto. Physician further attests that such Supervision Agreement(s) have been appropriately filed at each location where AHP(s) will practice, and/or with a state professional board, if applicable Ohio law requires filings at such location(s). b. Physician shall also supervise AHP(s) in accordance with (a) generally accepted medical practices; (b) all applicable federal and Ohio laws, rules and regulations; (c) the bylaws rules, regulations, policies and standards established from time to time by MCHP, or by the facilit(ies) where AHP(s) practice; (d) the requirements, standards and recommendations of the National Committee for Quality Assurance ( NCQA )), applicable state professional boards (including, but not limited to, the Ohio State Medical Board and the Ohio State Board of Nursing, as applicable, in accordance with AHP(s) licensure(s) or certification(s)), the Ohio Department of Health, the U.S. Department of Health and Human Services and any other applicable accrediting, regulating or licensing authorities and agencies; (e) the standards of applicable professional medical associations; (f) the Code of Ethics of the American Medical Association; (g) MCHP s mission, values and philosophies; and (h) all third party payor agreements that AHP(s) will be providing services under. c. Physician hereby attests that Physician s scope of practice is sufficiently similar to that of the AHP(s) identified in Exhibit A that Physician can provide adequate clinical supervision of AHP(s) in accordance with applicable law. 4. Credentialing. a. Physician shall cooperate in the completion of any AHP credentialing policy or process MCHP shall set forth, and shall have the burden of producing accurate information for proper evaluation of AHP(s) experience, training, current competence, past job performance, and health status, and of satisfying any reasonable requests for information or clarification made by MCHP, or any entity delegated thereby to assist in the credentialing process. b. Physician shall notify MCHP immediately in the event Physician becomes aware of any circumstance impairing AHP(s) ability to practice in accordance with the Supervision Agreement(s), or with any law, rule, guideline, or agreement described within Section 3(b) of this Addendum. c. Physician shall, upon notification by MCHP that an AHP has either failed to complete or failed to satisfy any AHP credentialing policy or process MCHP shall set forth, prohibit AHP from participating in the rendering of medical and related health care services to Members, as such services are described in the Agreement

3 5. No Release of Liability. Nothing in this Addendum is intended or shall be construed to relieve Physician of ultimate accountability for supervising AHP(s) in accordance with applicable state and federal law, nor to relieve AHP(s) from accountability for practicing within the scope of the Supervision Agreement, in accordance with applicable law and professional guidelines, and in accordance with such guidance and direction as Physician shall set forth. 6. Term, Termination and Amendment. a. The term of this Addendum shall begin on ( Effective Date ) and shall continue for a period of one (1) year thereafter, and shall renew automatically for successive one (1) year terms, unless sooner terminated as provided in Section 6(b) below. b. This Addendum may be terminated by MCHP at any time (i) upon notice to Physician; or (ii) upon the termination, without renewal, of any Supervision Agreement, or employment or other contractual arrangement pursuant to which AHP practices under the supervision of or in collaboration with Physician. In addition, this Addendum shall terminate contemporaneously with the termination of the Physician Services Agreement. c. This Addendum shall be amended unilaterally by Physician at any time, for the sole purpose of addition or deletion of AHP(s) from Exhibit A. Physician shall simultaneously notify MCHP of any such AHP addition or deletion, and provide copies of the amended Exhibit A upon MCHP s request. [REMAINDER OF THIS PAGE INTENTIONALLY BLANK] - 3 -

4 7. Relationship to Physician Services Agreement. Except as modified by this Addendum, the terms and conditions of the Agreement shall remain in full force and effect and shall be fully applicable to the supervision of AHP(s) under the terms of this Addendum. IN WITNESS WHEREOF, the parties hereto have executed or caused to be executed this Addendum as of the date first written above. PHYSICIAN By: MOUNT CARMEL HEALTH PARTNERS, INC. Its: - 4 -

5 Exhibit A List of AHPs Practicing Under Supervision of Physician - 5 -

ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION

ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION ADDENDUM ALLIED HEALTH PROFESSIONAL CARE COLLABORATION AND SUPERVISION This Addendum to PHYSICIAN GROUP SERVICES AGREEMENT ( Addendum ) is made by and between Mount Carmel Health Partners, Inc., an Ohio

More information

[LICENSED AND ACCREDITED ACUTE CARE HOSPITAL/CLINIC/OTHER]

[LICENSED AND ACCREDITED ACUTE CARE HOSPITAL/CLINIC/OTHER] AFFILIATION AGREEMENT BETWEEN [Facility Name] AND VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF MEDICINE AND VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM This Affiliation Agreement (hereinafter Agreement

More information

Last updated on April 23, 2017 by Chris Krummey - Managing Attorney-Transactions

Last updated on April 23, 2017 by Chris Krummey - Managing Attorney-Transactions Physician Assistant Supervision Agreement Instructions Sheet Outlined in this document the instructions for completing the Physician Assistant Supervision Agreement and forming a supervision agreement

More information

Stanford Health Care Lucile Packard Children s Hospital Stanford

Stanford Health Care Lucile Packard Children s Hospital Stanford Practitioners Page 1 of 11 I. PURPOSE To outline individuals who are authorized to provide care as an Allied Health Provider as well as describe which categories of individuals who will be processed under

More information

ADVANCED MANUFACTURING FUTURES PROGRAM REQUEST FOR PROPOSALS. Massachusetts Development Finance Agency.

ADVANCED MANUFACTURING FUTURES PROGRAM REQUEST FOR PROPOSALS. Massachusetts Development Finance Agency. ADVANCED MANUFACTURING FUTURES PROGRAM REQUEST FOR PROPOSALS Massachusetts Development Finance Agency 99 High Street, 11 th Floor, Boston, MA 02110 www.massdevelopment.com RFP Issued: September 25, 2013

More information

Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual

Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual PVH AHP Manual December 9, 2014 Table of Contents A. Comparison of Advanced and Dependent AHP 3 B. Authorizations of

More information

2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan HOUSE OFFICER EMPLOYMENT AGREEMENT

2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan HOUSE OFFICER EMPLOYMENT AGREEMENT 2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan SAMPLE CONTRACT ONLY HOUSE OFFICER EMPLOYMENT AGREEMENT This Agreement made this 23 rd of January 2012 between St. Joseph Mercy Oakland a member of

More information

Managed Care Organization Hospital Access Program Hospital Participation Agreement

Managed Care Organization Hospital Access Program Hospital Participation Agreement Managed Care Organization Hospital Access Program Hospital Participation Agreement The undersigned hospital ( Hospital ) and the undersigned Medicaid Managed Care Organization ( MCO ) hereby agree to participate

More information

RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit

RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit corporation ( Hospital ) and ( Resident ). In consideration

More information

Appendix B-1. Feasibility Study Task Order Template

Appendix B-1. Feasibility Study Task Order Template Appendix B-1 Feasibility Study Task Order Template Task Order between and the Massachusetts Clean Energy Technology Center This Task Order dated (the Effective

More information

WHEREAS, RISD is a political subdivision of the State of Texas and an independent public school system located in Dallas County, Texas; and

WHEREAS, RISD is a political subdivision of the State of Texas and an independent public school system located in Dallas County, Texas; and MEMORANDUM OF UNDERSTANDING Between the Richardson Independent School District and the Board of Directors of the RISD Excellence in Education Foundation This Memorandum of Understanding is between the

More information

AFFILIATION AGREEMENT FOR USE WITH A NURSING HEALTH AGENCY

AFFILIATION AGREEMENT FOR USE WITH A NURSING HEALTH AGENCY AFFILIATION AGREEMENT FOR USE WITH A NURSING HEALTH AGENCY THIS AGREEMENT, is made this day of, 19, by and between UNIVERSITY OF PENNSYLVANIA, (hereinafter referred to as University ), an educational institution

More information

VISITING SCIENTIST AGREEMENT. Between NORTH CAROLINA STATE UNIVERSITY. And

VISITING SCIENTIST AGREEMENT. Between NORTH CAROLINA STATE UNIVERSITY. And VISITING SCIENTIST AGREEMENT Between NORTH CAROLINA STATE UNIVERSITY And Rev. 5/15 THIS AGREEMENT made this day of 20, by and on behalf of North Carolina State University ( NC State ) located in Raleigh,

More information

NATIONWIDE CHILDREN S HOSPITAL / COLUMBUS, OHIO ADVANCED PRACTICE REGISTERED NURSE STANDARD CARE ARRANGEMENT (SCA)

NATIONWIDE CHILDREN S HOSPITAL / COLUMBUS, OHIO ADVANCED PRACTICE REGISTERED NURSE STANDARD CARE ARRANGEMENT (SCA) NATIONWIDE CHILDREN S HOSPITAL / COLUMBUS, OHIO ADVANCED PRACTICE REGISTERED NURSE STANDARD CARE ARRANGEMENT (SCA) I. STATEMENT OF PURPOSE A. Advanced Practice Registered Nurses (APRNs) at Nationwide Children

More information

MEDICAL LICENSURE COMMISSION OF ALABAMA ADMINISTRATIVE CODE CHAPTER 545 X 6 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES

MEDICAL LICENSURE COMMISSION OF ALABAMA ADMINISTRATIVE CODE CHAPTER 545 X 6 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES Medical Licensure Chapter 545 X 6 MEDICAL LICENSURE COMMISSION OF ALABAMA ADMINISTRATIVE CODE CHAPTER 545 X 6 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES TABLE OF CONTENTS 545 X 6.01 545

More information

Retest for Success ONCB Certification Examination Promotion Agreement

Retest for Success ONCB Certification Examination Promotion Agreement Retest for Success ONCB Certification Examination Promotion Agreement This agreement, dated the day of, 20, is entered into by the Orthopaedic Nurses Certification Board ( ONCB ), with offices located

More information

FIRST AMENDED Operating Agreement. North Carolina State University and XYZ Foundation, Inc. RECITALS

FIRST AMENDED Operating Agreement. North Carolina State University and XYZ Foundation, Inc. RECITALS FIRST AMENDED Operating Agreement North Carolina State University and XYZ Foundation, Inc. This Operating Agreement (Agreement) is made between North Carolina State University (NC State) and XYZ Foundation,

More information

CREDENTIALING Section 4

CREDENTIALING Section 4 Overview Credentialing is the process by which the appropriate peer-review bodies of Ohana Health Plan (the Plan) evaluate the credentials and qualifications of providers, i.e., physicians, allied health

More information

MEMORANDUM OF UNDERSTANDING. Between the

MEMORANDUM OF UNDERSTANDING. Between the MEMORANDUM OF UNDERSTANDING Between the Richardson Independent School District and the Board of Directors of the RISD Excellence in Education Foundation This Memorandum of Understanding is between the

More information

Centering In-House Training Agreement

Centering In-House Training Agreement Centering In-House Training Agreement This Centering In-House Training Agreement (the Agreement ) outlines the terms and conditions by and between, Inc. ( CHI ) and (enter customer legal name) having a

More information

PROVIDENCE HOSPITAL. Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE

PROVIDENCE HOSPITAL. Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE PROVIDENCE HOSPITAL Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE AGREEMENT, made and entered into this day of,, between Providence Hospital (hereinafter referred to as the Hospital) and

More information

DOCTORS HOSPITAL, INC. Medical Staff Bylaws

DOCTORS HOSPITAL, INC. Medical Staff Bylaws 3.1.11 FINAL VERSION; AS AMENDED 7.22.13; 10.20.16; 12.15.16 DOCTORS HOSPITAL, INC. Medical Staff Bylaws DMLEGALP-#47924-v4 Table of Contents Article I. MEDICAL STAFF MEMBERSHIP... 4 Section 1. Purpose...

More information

CREDENTIALING Section 5

CREDENTIALING Section 5 Overview Credentialing is the process used by the Plan to evaluate the qualifications and credentials of providers, physicians, allied health professionals, hospitals and ancillary facilities/health care

More information

Medical Staff Bylaws. A Medical Staff Document v11

Medical Staff Bylaws. A Medical Staff Document v11 Medical Staff Bylaws A Medical Staff Document 6822569v11 TABLE OF CONTENTS ARTICLE I NAME...6 ARTICLE II PURPOSES AND RESPONSIBILITIES...7 Page 2.1 Purposes....7 2.2 Responsibilities....7 ARTICLE III APPOINTMENT

More information

STATE-COUNTY AGREEMENT REGARDING TRANSFER OF PUBLIC FUNDS FOR ENHANCED MEDI-CAL PAYMENTS TO DOCTORS MEDICAL CENTER SAN PABLO/PINOLE

STATE-COUNTY AGREEMENT REGARDING TRANSFER OF PUBLIC FUNDS FOR ENHANCED MEDI-CAL PAYMENTS TO DOCTORS MEDICAL CENTER SAN PABLO/PINOLE STATE-COUNTY AGREEMENT REGARDING TRANSFER OF PUBLIC FUNDS FOR ENHANCED MEDI-CAL PAYMENTS TO DOCTORS MEDICAL CENTER SAN PABLO/PINOLE This Agreement is entered into between the California Department of Health

More information

TIFT REGIONAL MEDICAL CENTER MEDICAL STAFF POLICIES & PROCEDURES

TIFT REGIONAL MEDICAL CENTER MEDICAL STAFF POLICIES & PROCEDURES Title: Allied Health Professionals Approved: 2/02 Reviewed/Revised: 11/04; 08/10; 03/11; 5/14 Definition TIFT REGIONAL MEDICAL CENTER MEDICAL STAFF POLICIES & PROCEDURES P & P #: MS-0051 Page 1 of 7 For

More information

LIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee]

LIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee] PROJECT NUMBER _[project number]_ LIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee] This Agreement is by and between

More information

Advanced Practice Nurses Authority to Diagnose and Prescribe. Excellence Through Coordinated Patient Care. Copyright protected. information.

Advanced Practice Nurses Authority to Diagnose and Prescribe. Excellence Through Coordinated Patient Care. Copyright protected. information. Excellence Through Coordinated Patient Care Copyright protected information. Provided courtesy of the Illinois State Medical Society Advanced Practice Nurses Authority to Diagnose and Prescribe 12-1655-S

More information

WHEREAS, the AAEDC serves as a partner for community revitalization; and

WHEREAS, the AAEDC serves as a partner for community revitalization; and Memorandum of Understanding Between Anne Arundel County, Maryland, the City of Annapolis, and the Anne Arundel County Economic Development Corporation Regarding Shared Economic Development Programs THIS

More information

COMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA. Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY

COMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA. Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY COMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY 1.1 PURPOSE The purpose of this Policy is to set forth the criteria

More information

SPECIFICATION 13.BRAND TLD PROVISIONS

SPECIFICATION 13.BRAND TLD PROVISIONS SPECIFICATION 13.BRAND TLD PROVISIONS The Internet Corporation for Assigned Names and Numbers and [INSERT REGISTRY OPERATOR NAME] agree, effective as of, that this Specification 13 shall be annexed to

More information

Advanced Practice Nurse Authority to Diagnose and Prescribe

Advanced Practice Nurse Authority to Diagnose and Prescribe Advanced Practice Nurse Authority to Diagnose and Prescribe Copyright protected information. Provided courtesy of the Illinois State Medical Society ADVANCED PRACTICE NURSES AUTHORITY TO DIAGNOSE AND PRESCRIBE

More information

BOARD OF TRUSTEE BYLAWS THE ORTHOPEDIC HOSPITAL OF LUTHERAN HEALTH NETWORK

BOARD OF TRUSTEE BYLAWS THE ORTHOPEDIC HOSPITAL OF LUTHERAN HEALTH NETWORK BOARD OF TRUSTEE BYLAWS OF THE ORTHOPEDIC HOSPITAL OF LUTHERAN HEALTH NETWORK 1 MISSION STATEMENT Utilizing collaborative relationships with its physicians and staff, The Orthopedic Hospital of Lutheran

More information

RECITALS. WHEREAS, on July 1, 2008, Time Warner Telecom Holdings, Inc. changed its name to TW Telecom Holdings, Inc. ( TW Telecom ); and

RECITALS. WHEREAS, on July 1, 2008, Time Warner Telecom Holdings, Inc. changed its name to TW Telecom Holdings, Inc. ( TW Telecom ); and AMENDMENT NO. 3 TO CONTRACT NO. MA-07-600665 (FORMERLY MA-07-600655) BETWEEN THE COUNTY OF ORANGE AND LEVEL 3 COMMUNICATIONS, LLC FOR WIDE AREA NETWORK TRANSPORT SERVICES This Amendment, hereinafter referred

More information

BOARD OF SUPERVISORS BUSINESS MEETING ACTION ITEM. Incentive Package for the Expansion of Black Hops Farm, LLC

BOARD OF SUPERVISORS BUSINESS MEETING ACTION ITEM. Incentive Package for the Expansion of Black Hops Farm, LLC Date of Meeting: July 15, 2015 # 9 BOARD OF SUPERVISORS BUSINESS MEETING ACTION ITEM SUBJECT: ELECTION DISTRICT: Incentive Package for the Expansion of Black Hops Farm, LLC Catoctin District CRITICAL ACTION

More information

CREDENTIALING Section 8. Overview

CREDENTIALING Section 8. Overview Overview Credentialing is the process by which the appropriate peer review bodies of the Plan evaluate an individual applicant s background, education, post-graduate training, experience, work history,

More information

tuat*tkl-,zotz, AFFILIATION AGREEMENT By and Between Marshall University Joan C. Edwards School of Medicine and Pleasant Valley Hospital

tuat*tkl-,zotz, AFFILIATION AGREEMENT By and Between Marshall University Joan C. Edwards School of Medicine and Pleasant Valley Hospital M AFFILIATION AGREEMENT By and Between Marshall University Joan C. Edwards School of Medicine and Pleasant Valley Hospital tuat*tkl-,zotz, THIS AGREEMENT made thisa?,

More information

GUARANTEED ADMISSION AGREEMENT between The George Washington University and The Virginia Community College System

GUARANTEED ADMISSION AGREEMENT between The George Washington University and The Virginia Community College System GUARANTEED ADMISSION AGREEMENT between The George Washington University and The Virginia Community College System This Guaranteed Admission Agreement ("Agreement") is effective this 20 th day of November,

More information

City of Jacksonville, Alabama Public Square Overlay District. Façade Improvement Program APPLICATION AND AGREEMENT

City of Jacksonville, Alabama Public Square Overlay District. Façade Improvement Program APPLICATION AND AGREEMENT City of Jacksonville, Alabama Public Square Overlay District Façade Improvement Program APPLICATION AND AGREEMENT The following includes the Façade Improvement Program Description, Grant Application and

More information

MISSISSIPPI LEGISLATURE REGULAR SESSION 2017

MISSISSIPPI LEGISLATURE REGULAR SESSION 2017 MISSISSIPPI LEGISLATURE REGULAR SESSION 2017 By: Representative Dortch To: Public Health and Human Services HOUSE BILL NO. 86 1 AN ACT TO AMEND SECTIONS 73-15-5 AND 73-15-20, MISSISSIPPI 2 CODE OF 1972,

More information

MARTIN HEALTH SYSTEM

MARTIN HEALTH SYSTEM MARTIN HEALTH SYSTEM CREDENTIALING PROCEDURES MANUAL FOR ALLIED HEALTH PROFESSIONALS/DEPENDENT PRACTITIONERS Last Amended September 24, 2014 Approved 04/2012 Last reviewed in its entirety by Medical Staff

More information

MEDICAL STAFF CREDENTIALING MANUAL

MEDICAL STAFF CREDENTIALING MANUAL MEDICAL STAFF CREDENTIALING MANUAL 2016 MOUNT CLEMENS REGIONAL MEDICAL CENTER CREDENTIALING MANUAL TABLE OF CONTENTS I. PROCEDURES FOR APPOINTMENT 4 1. GENERAL PROCEDURE 4 2. APPLICATION FOR INITIAL APPOINTMENT

More information

Provider Rights. As a network provider, you have the right to:

Provider Rights. As a network provider, you have the right to: NETWORK CREDENTIALING AND SANCTIONS ValueOptions program for credentialing and recredentialing providers is designed to comply with national accrediting organization standards as well as local, state and

More information

EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT. July 1, 2017 June 30, 2018

EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT. July 1, 2017 June 30, 2018 EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT July 1, 2017 June 30, 2018 This Grant Agreement (the Agreement ) is entered into by and between the Family and Children First Administrative Agency

More information

UNIVERSITY OF KANSAS HOSPITAL ALLIED HEALTH PROFESSIONALS POLICY Approved ECMS September 26, 2013 Approved Hospital Authority October 8, 2013

UNIVERSITY OF KANSAS HOSPITAL ALLIED HEALTH PROFESSIONALS POLICY Approved ECMS September 26, 2013 Approved Hospital Authority October 8, 2013 UNIVERSITY OF KANSAS HOSPITAL ALLIED HEALTH PROFESSIONALS POLICY Approved ECMS September 26, 2013 Approved Hospital Authority October 8, 2013 I. Generally An allied health professional ( AHP ) is a health

More information

Details Effective Date: July 5, Modifications to the Condition of Participation: 42 CFR (a)(8) & (a)(9) (Hospital Governing Body) 42 CFR 4

Details Effective Date: July 5, Modifications to the Condition of Participation: 42 CFR (a)(8) & (a)(9) (Hospital Governing Body) 42 CFR 4 Telemedicine Credentialing and Privileging July 21, 2011 Objectives Outline the changes to CMS Conditions of Participation: revised regulations for telemedicine credentialing and privileging process. Discuss

More information

Justification for a Non-Competitive Procurement Process. Grant to Ross & Associates Environmental Consulting, Ltd.

Justification for a Non-Competitive Procurement Process. Grant to Ross & Associates Environmental Consulting, Ltd. Justification for a Non-Competitive Procurement Process Grant to Ross & Associates Environmental Consulting, Ltd. Introduction Before WCI, Inc. was created, technical and contracted support for the Western

More information

CITIZENS OBSERVING PATROL Truro Police Ride-A-Long Program

CITIZENS OBSERVING PATROL Truro Police Ride-A-Long Program Truro Police Department CITIZENS OBSERVING PATROL Truro Police Ride-A-Long Program Policy Number: Effective Date: November 1, 2001 REFERENCE: Accreditation Standards: Mass. Gen. Law Other: CORI Check Acknowledgement,

More information

AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT

AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT This agreement is made as of the day of, 2009 by and between the Mt. Diablo Unified School District, hereafter known

More information

Pro life Sunday Collection Guidelines

Pro life Sunday Collection Guidelines Pro life Sunday Collection Guidelines 1. The Pro life Sunday collection takes place on the third Sunday in June, Father s Day. 2. The parish collects and counts the funds and deposits them in the parish

More information

IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA

IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA HIGHMARK INC., and KEYSTONE HEALTH PLAN WEST, INC., v. Plaintiffs, UPMC, UPMC BEDFORD, UPMC EAST, UPMC HORIZON, UPMC MCKEESPORT, UPMC NORTHWEST,

More information

The Affiliation Agreement. DATED as of the day of, 20. Steve s Club National Program, a New Jersey nonprofit corporation (the National Program )

The Affiliation Agreement. DATED as of the day of, 20. Steve s Club National Program, a New Jersey nonprofit corporation (the National Program ) The Affiliation Agreement DATED as of the day of, 20. BETWEEN: AND Steve s Club National Program, a New Jersey nonprofit corporation (the National Program ), a, (the "Local Club") This Affiliation Agreement

More information

Session of 2008 No AN ACT

Session of 2008 No AN ACT MEDICAL PRACTICE ACT OF 1985 - STATE BOARD OF MEDICINE, JOINTLY PROMULGATED REGULATIONS, PHYSICIAN ASSISTANTS, RESPIRATORY CARE PRACTITIONERS, PHYSICIANS ASSISTANTS LICENSE AND RESPIRATORY CARE PRACTITIONER

More information

BAPTIST EYE SURGERY CENTER AT SUNRISE MEDICAL STAFF BYLAWS

BAPTIST EYE SURGERY CENTER AT SUNRISE MEDICAL STAFF BYLAWS 1 BAPTIST EYE SURGERY CENTER AT SUNRISE MEDICAL STAFF BYLAWS EFFECTIVE MARCH 28, 2014 2 PREAMBLE WHEREAS, Baptist Eye Surgery Center at Sunrise is an ambulatory surgical center owned and operated by Baptist

More information

THE MIRIAM HOSPITAL PROVIDENCE, RHODE ISLAND THE MIRIAM HOSPITAL MEDICAL STAFF BYLAWS

THE MIRIAM HOSPITAL PROVIDENCE, RHODE ISLAND THE MIRIAM HOSPITAL MEDICAL STAFF BYLAWS THE MIRIAM HOSPITAL PROVIDENCE, RHODE ISLAND THE MIRIAM HOSPITAL MEDICAL STAFF BYLAWS Adopted: April 30, 2012 Approved: June 7, 2012 Implemented: July 1, 2012 Revised: November 27, 2012 May 20, 2014 TABLE

More information

MASTER RELATIONSHIP AGREEMENT FOR THE OWNERSHIP, OPERATION, AND MANAGEMENT OF THE ST. CROIX VALLEY BUSINESS INCUBATOR

MASTER RELATIONSHIP AGREEMENT FOR THE OWNERSHIP, OPERATION, AND MANAGEMENT OF THE ST. CROIX VALLEY BUSINESS INCUBATOR MASTER RELATIONSHIP AGREEMENT FOR THE OWNERSHIP, OPERATION, AND MANAGEMENT OF THE ST. CROIX VALLEY BUSINESS INCUBATOR This Master Relationship Agreement is made by and among the CITY OF RIVER FALLS, WI,

More information

ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE

ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE CHAPTER 580-5-30B BEHAVIOR ANALYST LICENSING TABLE OF CONTENTS 580-5-30B-.01

More information

The University Hospital Medical Staff BYLAWS

The University Hospital Medical Staff BYLAWS The University Hospital Medical Staff BYLAWS October 2008 Page 1 of 77 The University Hospital Medical Staff Bylaws PREAMBLE WHEREAS, University Hospital is a health care entity of the University of Medicine

More information

J A N U A R Y 2,

J A N U A R Y 2, MEDICAL STAFF BYLAWS FRASER HEALTH AUTHOR ITY J A N U A R Y 2, 2 0 1 3 Page 2 of 39 TABLE OF CONTENTS TABLE OF CONTENTS... 2 INTRODUCTION... 4 PREAMBLE... 5 ARTICLE 1. DEFINITIONS... 7 ARTICLE 2. PURPOSE

More information

1) ELIGIBLE DISCIPLINES

1) ELIGIBLE DISCIPLINES PRACTITIONER S APPLICABLE TO ALL INDIVIDUAL NETWORK PARTICIPANTS AND APPLICANTS FOR THE PREFERRED PAYMENT PLAN NETWORK, MEDI-PAK ADVANTAGE PFFS NETWORK AND MEDI-PAK ADVANTAGE LPPO NETWORK of Arkansas Blue

More information

Commercial Water & Sewer Impact Fee Assistance

Commercial Water & Sewer Impact Fee Assistance Commercial Water & Sewer Impact Fee Assistance Introduction This program has been created to encourage new business in the downtown area. The program is meant to diversify the business mix, expand the

More information

CONDITIONS OF AGREEMENT

CONDITIONS OF AGREEMENT CONDITIONS OF AGREEMENT BETWEEN POLICE DEPARTMENT AND NORTH CENTRAL HIGHWAY SAFETY NETWORK, INC. PA AGGRESSIVE DRIVING ENFORCEMENT & EDUCATION PROJECT (PAADEEP) THIS CONDITIONS OF AGREEMENT made the day

More information

Hospital Crosswalk. Medicare Hospital Requirements to 2017 Joint Commission Hospital Standards & EPs. Joint Commission Equivalent Number EP 2 EP 1

Hospital Crosswalk. Medicare Hospital Requirements to 2017 Joint Commission Hospital Standards & EPs. Joint Commission Equivalent Number EP 2 EP 1 Hospital Crosswalk CFR Number 482.11 TAG: A-0020 482.11 Condition of Participation: Compliance with Federal, State and Local Laws 482.11(a) TAG: A-0021 LD.04.01.01 The hospital complies with law and regulation.

More information

LEXINGTON-FAYETTE URBAN COUNTY AIRPORT BOARD REQUEST FOR PROPOSALS. to provide INVESTMENT MANAGEMENT SERVICES. for BLUE GRASS AIRPORT

LEXINGTON-FAYETTE URBAN COUNTY AIRPORT BOARD REQUEST FOR PROPOSALS. to provide INVESTMENT MANAGEMENT SERVICES. for BLUE GRASS AIRPORT LEXINGTON-FAYETTE URBAN COUNTY AIRPORT BOARD REQUEST FOR PROPOSALS to provide INVESTMENT MANAGEMENT SERVICES for BLUE GRASS AIRPORT DATED: March 5, 2017 TABLE OF CONTENTS 1. NOTICE AND REQUEST FOR PROPOSALS...

More information

COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF MINE SAFETY COAL MINE RESCUE TEAM AGREEMENT

COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF MINE SAFETY COAL MINE RESCUE TEAM AGREEMENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF MINE SAFETY COAL MINE RESCUE TEAM AGREEMENT This AGREEMENT entered into by and between the Commonwealth of Pennsylvania, Department

More information

Administrative services which may be delegated to IPAs, Medical Groups, Vendors, or other organizations include:

Administrative services which may be delegated to IPAs, Medical Groups, Vendors, or other organizations include: Delegation Delegation This section contains information specific to medical groups, Independent Practice Associations (IPA), and Vendors contracted with Molina to provide medical care or services to Members,

More information

SBE 23 ILLINOIS ADMINISTRATIVE CODE

SBE 23 ILLINOIS ADMINISTRATIVE CODE SBE 23 ILLINOIS ADMINISTRATIVE CODE 401 401.2 TITLE 23: EDUCATION AND CULTURAL RESOURCES : EDUCATION CHAPTER I: STATE BOARD OF EDUCATION : NONPUBLIC ELEMENTARY AND SECONDARY SCHOOLS Section 401.2 Regulatory

More information

Fort Bend Independent School District. Small Business Enterprise Program Procedures

Fort Bend Independent School District. Small Business Enterprise Program Procedures Fort Bend Independent School District Small Business Enterprise Program Procedures Spring 2015 TABLE OF CONTENTS I. Summary Of Fort Bend Independent School District s Small Business Enterprise Program

More information

YORK HOSPITAL MEDICAL STAFF BYLAWS

YORK HOSPITAL MEDICAL STAFF BYLAWS YORK HOSPITAL MEDICAL STAFF BYLAWS Table of Contents ARTICLE I. NAME...4 1.1 NAME... 4 ARTICLE II. PURPOSES AND RESPONSIBILITIES OF THE MEDICAL STAFF.4 2.1 PURPOSES... 4 2.2 RESPONSIBILITIES... 4 ARTICLE

More information

WHEREAS, School engages in organized interscholastic sporting events in which School's students participate;

WHEREAS, School engages in organized interscholastic sporting events in which School's students participate; ATHLETIC TRAINER SERVICES AGREEMENT THIS ATHLETIC TRAINER SERVICES AGREEMENT ("Agreement") is entered into an effective as of this 24th day of _June_ 2016, by and between Midwest Division - LSH, LLC d/b/a

More information

MEDICAL STAFF BYLAWS/RULES AND REGULATIONS OF Grace Medical Center

MEDICAL STAFF BYLAWS/RULES AND REGULATIONS OF Grace Medical Center MEDICAL STAFF BYLAWS/RULES AND REGULATIONS OF Grace Medical Center P R E A M B L E WHEREAS, Grace Medical Center, hereinafter referred to as "Hospital", is operated by Lubbock Heritage Hospital, LLC. hereinafter

More information

EMERGENCY COMMUNICATIONS SYSTEM MAINTENANCE AGREEMENT BETWEEN THE MARIN EMERGENCY RADIO AUTHORITY (MERA) AND THE COUNTY OF MARIN (2005)

EMERGENCY COMMUNICATIONS SYSTEM MAINTENANCE AGREEMENT BETWEEN THE MARIN EMERGENCY RADIO AUTHORITY (MERA) AND THE COUNTY OF MARIN (2005) EMERGENCY COMMUNICATIONS SYSTEM MAINTENANCE AGREEMENT BETWEEN THE MARIN EMERGENCY RADIO AUTHORITY (MERA) AND THE COUNTY OF MARIN (2005) THIS AGREEMENT entered into by and between the COUNTY OF MARIN, a

More information

NURSING CONTRACT AGREEMENT BLACK HAWK COUNTY HEALTH DEPARTMENT AND CEDAR FALLS SCHOOL DISTRICT

NURSING CONTRACT AGREEMENT BLACK HAWK COUNTY HEALTH DEPARTMENT AND CEDAR FALLS SCHOOL DISTRICT NURSING CONTRACT AGREEMENT BLACK HAWK COUNTY HEALTH DEPARTMENT AND CEDAR FALLS SCHOOL DISTRICT This AGREEMENT is made as of August 14, 2017, by and between the undersigned contractors. This School Nursing

More information

THE ORTHOPEDIC HOSPITAL MEDICAL STAFF BYLAWS INDEX

THE ORTHOPEDIC HOSPITAL MEDICAL STAFF BYLAWS INDEX P a g e 1 THE ORTHOPEDIC HOSPITAL MEDICAL STAFF BYLAWS INDEX PAGES P R E A M B L E 4 D E F I N I T I O N S 5-6 ARTICLE I NAME 7 ARTICLE II PURPOSES & RESPONSIBILITIES 2.1 PURPOSE 7-8 2.2 RESPONSIBILITIES

More information

PROVIDENCE HOLY FAMILY HOSPITAL AND PROVIDENCE SACRED HEART MEDICAL CENTER

PROVIDENCE HOLY FAMILY HOSPITAL AND PROVIDENCE SACRED HEART MEDICAL CENTER BYLAWS OF THE MEDICAL STAFF OF PROVIDENCE HOLY FAMILY HOSPITAL AND PROVIDENCE SACRED HEART MEDICAL CENTER TABLE OF CONTENTS PREAMBLE...1 ARTICLE I DEFINITIONS...2 ARTICLE II PURPOSE...3 ARTICLE III MEDICAL

More information

AMENDMENT 1 TO AGREEMENT BETWEEN THE DEPARTMENT OF ECONOMIC OPPORTUNITY AND FLORIDA SPORTS FOUNDATION

AMENDMENT 1 TO AGREEMENT BETWEEN THE DEPARTMENT OF ECONOMIC OPPORTUNITY AND FLORIDA SPORTS FOUNDATION AMENDMENT 1 TO AGREEMENT BETWEEN THE DEPARTMENT OF ECONOMIC OPPORTUNITY AND On August 31, 2017, the State of Florida, Department of Economic Opportunity (hereinafter DEPARTMENT ), and the Florida Sports

More information

EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT. July 1, 2018 June 30, 2019

EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT. July 1, 2018 June 30, 2019 EARLY INTERVENTION SERVICE COORDINATION GRANT AGREEMENT July 1, 2018 June 30, 2019 This Grant Agreement (the Agreement ) is entered into by and between the Family and Children First Administrative Agency

More information

CONSOLIDATED OPERATING ASSISTANCE GRANT AGREEMENT. For use with dotgrants Grant Applications

CONSOLIDATED OPERATING ASSISTANCE GRANT AGREEMENT. For use with dotgrants Grant Applications SAP Document Number: EG00002436 SAP Vendor Number: 147429 Federal ID Number: 251365284 Federal Grant: $275,000.00 State Grant: $2,260,966.00 CONSOLIDATED OPERATING ASSISTANCE GRANT AGREEMENT FISCAL YEAR

More information

GRANT AWARD AGREEMENT XX-XXXX-XXX-XX

GRANT AWARD AGREEMENT XX-XXXX-XXX-XX GRANT AWARD AGREEMENT XX-XXXX-XXX-XX THIS GRANT AWARD AGREEMENT ( Agreement ) is made and entered by and between The Missouri Foundation for Health ( Foundation ) and ( Grantee ). WHEREAS, Grantee has

More information

BYLAWS OF THE MEDICAL STAFF

BYLAWS OF THE MEDICAL STAFF BYLAWS OF THE MEDICAL STAFF CENTRAL MAINE MEDICAL CENTER LEWISTON, MAINE With updates adopted by the Medical Staff on September 14, 2017 Richard Goldstein, M.D. President Approved by the Governing Body

More information

A. The term "Charter" means the Charter of the City and County of San Francisco.

A. The term Charter means the Charter of the City and County of San Francisco. 1 BYLAWS OF THE GOVERNING BODY FOR SAN FRANCISCO GENERAL HOSPITAL AND TRAUMA CENTER PREAMBLE WHEREAS, San Francisco General Hospital and Trauma Center is a public hospital and a division of the Department

More information

ASSEMBLY BILL No. 214

ASSEMBLY BILL No. 214 AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE JULY, 00 AMENDED IN SENATE JUNE, 00 AMENDED IN SENATE JUNE, 00 AMENDED IN SENATE AUGUST 0, 00 california

More information

Effective Date: 1/13

Effective Date: 1/13 North Shore-LIJ Health System is now Northwell Health POLICY TITLE: Disaster Privileging ADMINISTRATIVE POLICY AND PROCEDURE MANUAL POLICY #: 100.002 System Approval Date: 6/18/15 Site Implementation Date:

More information

EUROPEAN ORTHODONTIC SOCIETY RESEARCH GRANTS

EUROPEAN ORTHODONTIC SOCIETY RESEARCH GRANTS EUROPEAN ORTHODONTIC SOCIETY RESEARCH GRANTS TERMS AND CONDITIONS OF GRANT AWARDS The European Orthodontic Society (EOS) awards grants for research into all aspects of orthodontics. DEFINITIONS AND ABBREVIATIONS:

More information

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED Dear Applicant: Enclosed in this reappointment application for membership to the Guadalupe Regional Medical Center (GRMC) Allied Health Professionals Staff, you will find the following. Allied Health Professional

More information

JAMAICA HOSPITAL MEDICAL CENTER RESIDENT AGREEMENT OF APPOINTMENT AND EMPLOYMENT

JAMAICA HOSPITAL MEDICAL CENTER RESIDENT AGREEMENT OF APPOINTMENT AND EMPLOYMENT JAMAICA HOSPITAL MEDICAL CENTER RESIDENT AGREEMENT OF APPOINTMENT AND EMPLOYMENT FOR THE ACADEMIC YEAR 2015-2016 This Agreement of Appointment and Employment between Jamaica Hospital Medical Center (Hospital)

More information

SENATE AMENDED PRIOR PRINTER'S NOS. 2612, 3013, 3223 PRINTER'S NO THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL

SENATE AMENDED PRIOR PRINTER'S NOS. 2612, 3013, 3223 PRINTER'S NO THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL SENATE AMENDED PRIOR PRINTER'S NOS. 2612, 3013, 3223 PRINTER'S NO. 4112 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL No. 1804 Session of 2007 INTRODUCED BY YUDICHAK, SOLOBAY, K. SMITH, SIPTROTH, PYLE,

More information

RULES AND REGULATIONS OF THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS, INC.

RULES AND REGULATIONS OF THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS, INC. RULES AND REGULATIONS OF THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS, INC. Health Care Quality and Management (HCQM) Certification and Diplomate Status Certification in Health

More information

CREDENTIALING PROCEDURES MANUAL MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA

CREDENTIALING PROCEDURES MANUAL MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA January 16, 1984 Revised: October 18, 1984 January 19, 1989 April 17, 1989 April 26, 1990 December 20, 1990 January 21, 1993 May 27, 1993 July

More information

Hospital Crosswalk. Medicare Hospital Requirements to 2012 Joint Commission Hospital Standards & EPs

Hospital Crosswalk. Medicare Hospital Requirements to 2012 Joint Commission Hospital Standards & EPs Hospital Crosswalk CFR Number Standards and Elements of Performance 482.11 TAG: A-0020 482.11 Condition of Participation: Compliance with Federal, State and Local Laws 482.11(a) TAG: A-0021 LD.04.01.01

More information

GDPR DATA PROCESSING ADDENDUM. (Revision March 2018)

GDPR DATA PROCESSING ADDENDUM. (Revision March 2018) GDPR DATA PROCESSING ADDENDUM (Revision March 2018) From 25 May 2018 the GDPR obliges a Controller to have a written agreement containing prescribed provisions with any Processor that it uses. This General

More information

NOTICE OF REQUEST FOR PROPOSALS

NOTICE OF REQUEST FOR PROPOSALS NOTICE OF REQUEST FOR PROPOSALS Competitive sealed proposals for professional services will be received by the Contracting Agency, Guadalupe County, New Mexico, for RFP No. 2014-005. The Contracting Agency

More information

Disadvantaged Business Enterprise Supportive Services Program

Disadvantaged Business Enterprise Supportive Services Program ARKANSAS STATE HIGHWAY AND TRANSPORTATION DEPARTMENT Equipment and Procurement Division REQUEST FOR PROPOSALS (RFP) No: 15-001P Disadvantaged Business Enterprise Supportive Services Program Proposals must

More information

AGENCY PARTNERSHIP AGREEMENT

AGENCY PARTNERSHIP AGREEMENT AGENCY PARTNERSHIP AGREEMENT Between United Way of Monroe County 135 Warner Dr., PO Box 790, Tannersville, PA, 18372 (Referred to hereinafter as UWMC) and {partner agency name} (Referred to hereinafter

More information

GLACIAL RIDGE HEALTH SYSTEM MEDICAL STAFF BYLAWS

GLACIAL RIDGE HEALTH SYSTEM MEDICAL STAFF BYLAWS GLACIAL RIDGE HEALTH SYSTEM MEDICAL STAFF BYLAWS February 2016 Page 2 of 31 GLACIAL RIDGE HOSPITAL DISTRICT dba GLACIAL RIDGE HEALTH SYSTEM MEDICAL STAFF BYLAWS Index Preamble 3 Definitions 4 Article I:

More information

RECITALS: 2. Agency operates facilities licensed by the State of North Carolina.

RECITALS: 2. Agency operates facilities licensed by the State of North Carolina. NORTH CAROLI NA CUMBERLAND CO UNTY AFFILIAT ION AGREEMENT THIS AFFILI ATION AGREEMENT is made this day of March 2013,by and between FAYETTEVILLE TECHNICAL COMMUNITY COLLEGE, a non-profit corporation created

More information

KIDMED SCREENING CLINIC

KIDMED SCREENING CLINIC LOUISIANA Department of HEALTH and HOSPITALS ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) KIDMED SCREENING CLINIC (PT66) Revised 10/06 Louisiana Medicaid

More information

SAMPLE MEDICAL STAFF BYLAWS PROVISIONS FOR CREDENTIALING AND CORRECTIVE ACTION

SAMPLE MEDICAL STAFF BYLAWS PROVISIONS FOR CREDENTIALING AND CORRECTIVE ACTION FOR CREDENTIALING AND CORRECTIVE ACTION [NOTE: THESE ARE RELATING TO CREDENTIALING AND CORRECTIVE ACTION. THE SAMPLE PROVISIONS MUST BE REVIEWED AND REVISED DEPENDING ON RELEVANT CIRCUMSTANCES, INCLUDING

More information

Manufacturer Job Creation and Investment Program

Manufacturer Job Creation and Investment Program CITY OF CRYSTAL LAKE Manufacturer Job Creation and Investment Program GRANT APPLICATION FORM ADMINISTERED BY: CITY OF CRYSTAL LAKE PLANNING & ECONOMIC DEVELOPMENT 100 W. WOODSTOCK STREET CRYSTAL LAKE,

More information

THE CHILDREN'S COLLABORATIVE (SERVING NORMAN COUNTY FAMILIES) GOVERNANCE AGREEMENT

THE CHILDREN'S COLLABORATIVE (SERVING NORMAN COUNTY FAMILIES) GOVERNANCE AGREEMENT THE CHILDREN'S COLLABORATIVE (SERVING NORMAN COUNTY FAMILIES) GOVERNANCE AGREEMENT The agreement made and entered into this 1 st day of February, 1999 (amended November 2000, January 2005, March 2007 and

More information